Provider Demographics
NPI:1023324092
Name:DYKE, PHILIP (LMT)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:DYKE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 20TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2494
Mailing Address - Country:US
Mailing Address - Phone:772-569-7770
Mailing Address - Fax:772-569-7770
Practice Address - Street 1:3975 20TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2494
Practice Address - Country:US
Practice Address - Phone:772-569-7770
Practice Address - Fax:772-569-7770
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-20703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist